Jourdan T. Holder

Insertion depth impacts speech perception and hearing preservation for lateral wall electrodes

1) Examine angular insertion depths (AID) and scalar location of Med‐El (GmbH Innsbruck, Austria) electrodes; and 2) determine the relationship between AID and audiologic outcomes controlling for scalar position.

Speech Understanding in Children With Normal Hearing: Sound Field Normative Data for BabyBio, BKB-SIN, and QuickSIN.

Objective: The primary goal was to establish normative data for the Pediatric AzBio “BabyBio,” QuickSIN, and BKB-SIN measures in the sound field for children with normal hearing. Setting: Tertiary care hospital; cochlear implant (CI) program. Patients: Forty-one children with normal hearing were recruited across four age groups (5–6, 7–8, 9–10, and 11–12 yr). Interventions: Sentence recognition testing was assessed at four different signal-to-noise ratios (SNRs, +10, +5, 0, and −5 dB) for BabyBio sentences as well as for the BKB-SIN and QuickSIN tests. All measures were presented in the sound field at 60 dBA except QuickSIN, which was presented at 70 dBA. Main Outcome Measures: BabyBio sentence recognition, BKB-SIN SNR-50, and QuickSIN SNR-50 were analyzed to establish sound field norms. Results: BabyBio sentence recognition approached ceiling at all SNRs with mean scores ranging from 86% at −5 dB SNR to 99.3% at +10 dB SNR. Mean QuickSIN SNR-50 was 6.6 dB. Mean BKB-SIN SNR-50 was 1.6 dB with sound field data being consistent with insert earphone normative data in the BKB-SIN manual. Performance for all measures improved with age. Conclusion: Children with normal hearing achieve ceiling-level performance for BabyBio sentence recognition at SNRs used for clinical CI testing (≥0 dB SNR) and approach ceiling level even at −5 dB SNR. Consistent with previous reports, speech recognition in noise improved with age from 5 to 12 years in children with normal hearing. Thus, speech recognition in noise might also increase in the CI population across the same age range warranting age-specific norms for CI recipients. Last, the QuickSIN test could be substituted for the BKB-SIN test with appropriate age-normative data.

Intra- and Postoperative Electrocochleography May Be Predictive of Final Electrode Position and Postoperative Hearing Preservation

Introduction: The objectives of the current study were to (1) determine the relationship between electrocochleography (ECochG), measured from the cochlear implant (CI) electrode array during and after implantation, and postoperative audiometric thresholds, (2) determine the relationship between ECochG amplitude and electrode scalar location determined by computerized tomography (CT); and (3) determine whether changes in cochlear microphonic (CM) amplitude during electrode insertion were associated with postoperative hearing. Materials and Methods: Eighteen subjects undergoing CI with an Advanced Bionics Mid-Scala device were prospectively studied. ECochG responses were recorded using the implant coupled to a custom signal recording unit. ECochG amplitude collected intraoperatively concurrent with CI insertion and at activation was compared with audiometric thresholds postoperatively. Sixteen patients also underwent postoperative CT to determine scalar location and the relationship to ECochG measures and residual hearing. Results: Mean low-frequency pure tone average (LFPTA) increased following surgery by an average of 28 dB (range 8–50). Threshold elevation was significantly greater for electrodes with scalar dislocation. No correlation was found between intraoperative ECochG and postoperative behavioral thresholds collapsed across frequency; however, mean differences in thresholds measured by intraoperative ECochG and postoperative audiometry were significantly smaller for electrodes inserted completely within scala tympani (ST) vs. those translocating from ST to scala vestibuli. A significant correlation was observed between postoperative ECochG thresholds and behavioral thresholds obtained at activation. Discussion: Postoperative audiometry currently serves as a marker for intracochlear trauma though thresholds are not obtained until device activation or later. When measured at the same time-point postoperatively, low-frequency ECochG thresholds correlated with behavioral thresholds. Intraoperative ECochG thresholds, however, did not correlate significantly with postoperative behavioral thresholds suggesting that changes in cochlear physiology occur between electrode insertion and activation. ECochG may hold clinical utility providing surgeons with feedback regarding insertion trauma due to scalar translocation, which may be predictive of postoperative hearing preservation. Conclusion: CI insertion trauma is generally not evident until postoperative audiometry when loss of residual hearing is confirmed. ECochG has potential to provide estimates of trauma during insertion as well as reliable information regarding degree of hearing preservation.

Predictive factors for short‐ and long‐term hearing preservation in cochlear implantation with conventional‐length electrodes

The aims of this study were to investigate short‐ and long‐term rates of hearing preservation after cochlear implantation and identify factors that impact hearing preservation.

Real-Time Intracochlear Electrocochleography Obtained Directly Through a Cochlear Implant

HYPOTHESIS Utilizing the cochlear implant to record electrophysiologic responses during device placement is a feasible and efficacious technique for monitoring near real-time cochlear physiology during and following electrode insertion. BACKGROUND Minimizing intracochlear trauma during cochlear implantation has emerged as a highly researched area to help improve patient performance. Currently, conventional cochlear implant technology allows for the recording of electrically evoked compound action potentials (eCAPs). Acoustically evoked potentials may be more sensitive in detecting physiologic changes occurring as a result of electrode insertion. Electrocochleography obtained from within the cochlea allows hair cell and neural response monitoring along the cochlear spiral at locations where changes most likely would occur. METHODS Intracochlear electrocochleography (ECochG) was recorded from the cochlear implant during surgery in 14 subjects. A long acquisition time (54.5 ms), capable of measuring potentials from the low frequency-serving apical region of the cochlea (125 and 500 Hz) was employed. Two distinct intracochlear processing methods were used and compared in obtaining electrophysiologic data. RESULTS Measureable intracochlear ECochG responses were obtained from all 14 participants. The 1st harmonic distortions (cochlear microphonic and auditory nerve neurophonic) generally increased steadily with electrode insertion. Electrode and frequency scan following insertion revealed that response amplitude varied based on location of recording electrode and frequency of stimulation. Exquisite sensitivity to manipulation during round window muscle packing was demonstrated. CONCLUSION Intracochlear ECochG recorded from the electrode array of the cochlear implant is a highly feasible technique that sheds light on cochlear micromechanics during cochlear implant electrode placement.

Cochlear implantation for single-sided deafness and tinnitus suppression

OBJECTIVE To quantify the potential effectiveness of cochlear implantation for tinnitus suppression in patients with single-sided deafness using the Tinnitus Handicap Inventory. METHODS The study included 12 patients with unilateral tinnitus who were undergoing cochlear implantation for single-sided deafness. The Tinnitus Handicap Inventory was administered at the patients cochlear implant candidacy evaluation appointment prior to implantation and every cochlear implant follow-up appointment, except activation, following implantation. Patient demographics and speech recognition scores were also retrospectively recorded using the electronic medical record. RESULTS A significant reduction was found when comparing Tinnitus Handicap Inventory score preoperatively (61.2±27.5) to the Tinnitus Handicap Inventory score after three months of cochlear implant use (24.6±28.2, p=0.004) and the Tinnitus Handicap Inventory score beyond 6months of CI use (13.3±18.9, p=0.008). Further, 45% of patients reported total tinnitus suppression. Mean CNC word recognition score improved from 2.9% (SD 9.4) pre-operatively to 40.8% (SD 31.7) by 6months post-activation, which was significantly improved from pre-operative scores (p=0.008). CONCLUSION The present data is in agreement with previously published studies that have shown an improvement in tinnitus following cochlear implantation for the large majority of patients with single-sided deafness.

Prominent Messages in Television Drama Switched at Birth Promote Attitude Change Toward Deafness

The study at hand employed a pre- versus posttest experimental design to test the effects of television drama Switched at Birth on viewers’ attitudes toward deafness. This program tells the story of two teenage girls (one of whom is deaf) and their struggles to relate to their peers and families after discovering they were switched as newborns. Two hundred eleven female adults completed pre- and postexposure measures utilizing Cooper, Rose, and Masons (2004) Attitudes to Deafness measure, the items of which were categorized according to thematic dimensions. After exposure to one of three episodes, viewers’ attitudes toward deafness significantly improved overall, although significant differences in attitude changes varied by episodes and dimensions. The three thematic dimensions that were most strongly represented in the program (social interaction, deafness as a handicap, and language issues) appeared to show the strongest attitude change. Positive attitude changes were observed on social interaction and deafness as handicap dimensions, which was consistent with program content depicting positive deaf-hearing friendships and capable deaf characters. However, attitudes on the language issues dimension showed a negative shift, possibly due to the way that deaf characters communicated with hearing characters onscreen.

Current Profile of Adults Presenting for Preoperative Cochlear Implant Evaluation

Considerable advancements in cochlear implant technology (e.g., electric acoustic stimulation) and assessment materials have yielded expanded criteria. Despite this, it is unclear whether individuals with better audiometric thresholds and speech understanding are being referred for cochlear implant workup and pursuing cochlear implantation. The purpose of this study was to characterize the mean auditory and demographic profile of adults presenting for preoperative cochlear implant workup. Data were collected prospectively for all adult preoperative workups at Vanderbilt from 2013 to 2015. Subjects included 287 adults (253 postlingually deafened) with a mean age of 62.3 years. Each individual was assessed using the minimum speech test battery, spectral modulation detection, subjective questionnaires, and cognitive screening. Mean consonant-nucleus-consonant word scores, AzBio sentence scores, and pure-tone averages for postlingually deafened adults were 10%, 13%, and 89 dB HL, respectively, for the ear to be implanted. Seventy-three individuals (25.4%) met labeled indications for Hybrid-L and 207 individuals (72.1%) had aidable hearing in the better hearing ear to be used in a bimodal hearing configuration. These results suggest that mean speech understanding evaluated at cochlear implant workup remains very low despite recent advancements. Greater awareness and insurance accessibility may be needed to make cochlear implant technology available to those who qualify for electric acoustic stimulation devices as well as individuals meeting conventional cochlear implant criteria.

Participant-generated Cochlear Implant Programs: Speech Recognition, Sound Quality, and Satisfaction.

Objective: To determine whether patient-derived programming of ones cochlear implant (CI) stimulation levels may affect performance outcomes. Background: Increases in patient population, device complexity, outcome expectations, and clinician responsibility have demonstrated the necessity for improved clinical efficiency. Methods: Eighteen postlingually deafened adult CI recipients (mean = 53 years; range, 24–83 years) participated in a repeated-measures, within-participant study designed to compare their baseline listening program to an experimental program they created. Results: No significant group differences in aided sound-field thresholds, monosyllabic word recognition, speech understanding in quiet, speech understanding in noise, nor spectral modulation detection (SMD) were observed (p > 0.05). Four ears (17%) improved with the experimental program for speech presented at 45 dB SPL and two ears (9%) performed worse. Six ears (27.3%) improved significantly with the self-fit program at +10 dB signal-to-noise ratio (SNR) and four ears (26.6%) improved in speech understanding at +5 dB SNR. No individual scored significantly worse when speech was presented in quiet at 60 dB SPL or in any of the noise conditions tested. All but one participant opted to keep at least one of the self-fitting programs at the completion of this study. Participants viewed the process of creating their program more favorably (t = 2.11, p = 0.012) and thought creating the program was easier than the traditional fitting methodology (t = 2.12, p = 0.003). Average time to create the self-fit program was 10 minutes, 10 seconds (mean = 9:22; range, 4:46–24:40). Conclusions: Allowing experienced adult CI recipients to set their own stimulation levels without clinical guidance is not detrimental to success.